3 Things to Consider When Choosing Assisted Living vs. In-Home Care

Deciding between assisted living and in-home care is a tough choice.

When your parent or spouse needs assistance in their daily life, the first thing to do is understand the situation and create a realistic plan to help them live safely and comfortably.

At this point, many families end up at a crossroads. Is assisted living the right choice? Or would hiring an in-home caregiver be better? It’s a complex decision and the answer depends on your specific situation.

This article shares what you need to know about the three essential factors to consider: how much help they need, the key differences between assisted living vs. home care and the financial situation. Knowing the facts helps you make the best choice for – or with – your older adult.

Figure out How Much Help They Need

Before making any decisions, it’s necessary to find out how much help your older adult needs and compare that with how much help is already available. Previously, we’ve talked about understanding their needs in 8 key areas of life and being realistic about how much help family will provide.

First, make a list of everything your older adult needs help with on a daily, weekly and monthly basis. Being able to see the whole picture helps you choose the correct level of care.

Next, be realistic about how much help you, family or friends and neighbors will provide. It’s important to think about this in terms of long-term, ongoing help – a few weeks or months isn’t going to be enough.

After comparing those two lists, you’ll have a better sense for the tasks your older adult will need additional help with – anything that isn’t already covered. In some cases, looking at this list makes it obvious that in-home care will work best. In other cases, assisted living might be the clear choice.

But for many, the decision still needs careful consideration. Knowing more about in-home care vs. assisted living will help you to make an informed choice.

Understand the Key Differences

Before you can choose between in-home care and assisted living, it’s important to understand how they each work. Here are the basics and key pros and cons for each.

In-home Care: Pros and Cons

In-home care is when a caregiver is hired to come into the home to help seniors with activities of daily living. This enables your older adult to continue living safely at home.

The specific help provided depends on the older adult’s needs and could include meal preparation, getting around the house, transportation, bathing, dressing, using the toilet, etc.

The pros include that the senior gets one-on-one care tailored to their needs and preferences and can stay in their home or a relative’s home as they age. Also, costs can be lower depending on hours of care needed and caregiver skill level. The family gets to choose the caregiver and the senior gets to know one caregiver, rather than being cared for by many different people.

There is also flexibility in care arrangements. For example, different types of care could be combined to lower costs, increase social interaction, or provide medical-type care – family help, adult day programs, privately-hired caregivers, agency caregivers and home health care.

The cons to consider are high costs if 24/7 care is needed and that ongoing family involvement is needed for hiring and managing caregivers, as well as planning backup care options. There is also potential for social isolation, which can contribute to depression, cognitive decline or health problems.

In addition, the home may need modifications for safety or wheelchair accessibility. And of course, housekeeping and home maintenance need to be done and groceries, personal care and household supplies need to be bought.

Assisted Living: Pros and Cons

An assisted living community is a place where many seniors live, in rooms or small apartments. Most communities offer a wide range of care options, from seniors who are mostly independent to those who need a high level of care.
Services like meals, transportation, group activities, and housekeeping are typically included in the monthly fee.

The pros for assisted living are that it is a more affordable way to get 24/7 supervision and care and family caregivers can focus more on the relationship rather than on care needs. The senior has plenty of opportunities for social interaction with other residents and the family doesn’t need to worry about hiring, scheduling or managing caregivers. Finally, the level of care can be ramped up as needed because staff is already in place

The cons include the fact that one-on-one care won’t be as personal or consistent as it is at home; frequent changes in staff are common and the quality of care can vary depending on the staff. If significant one-on-one care is needed, hiring (and paying out-of-pocket for) a private aide may become necessary

Another consideration is that seniors could get kicked out of the community for a variety of reasons with little advanced notice. As well, the senior may not enjoy being in a group living environment

Now that you know more about assisted living and in home care, the choice between them is probably becoming clearer. The next critical item to consider is the cost of care.

Understand the Financial Situation

Before you can make a choice about assisted living or in home care, you need to know how each choice would work with your older adult’s budget.

Figuring out assisted living and in-home care costs isn’t easy and is specific to each person’s needs, location and how much family help they have. This takes some work, but it’s worth the effort because it helps you plan for the future and avoid unpleasant scenarios like your older adult suddenly running out of money.

The best thing to do is to call around to get actual pricing information from assisted living communities you’d consider and in-home care providers you might use. That way, you’ll know how much it would cost to get the level of care your older adult needs in the city they live in.

A faster, but less accurate approach is to use averages from an online long term care cost estimating tool. According to Genworth, the 2016 national average monthly cost for in-home care was $3861 (for 44 hours of care per week). The 2016 national average monthly cost for assisted living was $3628.

There will be many factors to consider because you’re basically doing financial planning for the next five to 10 years of your older adult’s life. If analyzing and comparing costs becomes overwhelming, ask a trusted relative or friend for help. Or, consult a reputable financial adviser or accountant.

Here’s an overview of the key costs you’ll need to take into account:

Monthly In-home Care Costs

First, you need to account for the hours of care needed multiplied by the caregiver hourly rate. Next, factor in household expenses like groceries and meal preparation, personal care supplies, household supplies, housekeeping and laundry. You will also need to add in costs for rent or mortgage and property taxes as well as utilities, water, and garbage, plus home and yard maintenance. Finally, transportation expenses need to be added up.

Assisted Living Costs

Assisted living fees vary by community so don’t assume that most services will be covered by the base monthly rate. That’s why it’s important to ask for a list of all potential fees on top of the monthly rate. You never know which of those services your older adult might need.

In addition to the monthly base rate, common additional fees include housekeeping and laundry; personal care supplies; meals, snacks, or in-room dining; and overnight visitors – like you! You also need to factor in any additional fees based on the level of care needed.

After adding up the actual costs, you’ll have a good idea of which option fits better in your older adult’s budget, assisted living or in-home care.

Bottom Line

Choosing between assisted living and in-home care involves so many factors, both personal and financial. Making the decision can feel overwhelming. Remember that you don’t have to make an all-or-nothing choice.

If you’re really unsure, start with home care. Give it time to see if it’s working – there’s an adjustment period while you get the arrangements in place and get the caregiver and family help up to speed. If home care ends up not working out, or if the cost is too high to sustain, then you’ll know that assisted living is the way to go.

Have you been thinking about which type of care is right for your older adult? Or have you already made the decision? What helped you most when you were weighing the options? Please share with fellow Sixty and Me readers.

Connie Chow is a founder of DailyCaring.com, a website and email newsletter with free, practical caregiving tips for families caring for older adults. Her mission is to connect caregivers with trustworthy advice and resources. Connie’s insights are in The Huffington Post, BlogHer, About.com, and more. Sign up for helpful caregiving advice at DailyCaring.com.